title: Pilot study of a new model for managing hypertension in an uninsured population.
abstract: For millions of uninsured Americans who have hypertension, quality medical care is too expensive to access with any regularity. The Community-based Chronic Disease Management (CCDM) Clinic was created to deliver clinical care for medically uninsured patients in a setting of low resources and high need. CCDM's model melds nurse-led teams with the chronic disease model and uses evidence-based clinical decision protocols. This new model of care differs from traditional models. CCDM conducted a nonrandomized prospective trial of the effectiveness of this new model of care. The intervention included free education, medications, and laboratory investigations. For hypertensives treated for 6 months and 1 year, national benchmark goals were reached for 45% (50/110, P < .00005) and 56% (43/77, P < .00005) of patients, respectively, compared with 18% and 22% being at goal at initial presentation. The CCDM model may have implications for health service delivery in insured populations as well. Further study is warranted.
authors.affiliation: Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. jsanders@mcw.edu
authors.forename: James
authors.initials: J
authors.lastname: Sanders
authors.forename: Clare
authors.initials: C
authors.lastname: Guse
authors.forename: Berthrand C
authors.initials: BC
authors.lastname: Onuoha
mesh_terms: D000328:Adult; D019985:Benchmarking; D002908:Chronic Disease / Q000191:economics / Q000628:therapy; D003153:Community Health Services / Q000191:economics / Q000592:standards; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D019468:Disease Management; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D010865:Pilot Projects; D011203:Poverty; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D011446:Prospective Studies
keywords: community medicine; hypertension; medically uninsured; primary care; therapy